Impact of weight loss and eating difficulties on health-related quality of life up to 10 years after oesophagectomy for cancer.

BACKGROUND: Severe weight loss is experienced by patients with eating difficulties after surgery for oesophageal cancer. The aim of this prospective cohort study was to asssess the influence of eating difficulties and severe weight loss on health-related quality of life (HRQoL) up to 10 years after oesophagectomy. METHODS: Data on bodyweight and HRQoL were collected at 6 months, 3, 5 and 10 years in patients who underwent surgery for oesophageal cancer in Sweden between 2001 and 2005. Exposures were percentage weight loss, and eating difficulties defined by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-OES18 questionnaire. Outcomes were HRQoL scores from the EORTC QLQ-C30 questionnaire. Repeated-measures ANOVA, adjusting for potential confounders, was used to assess the association between eating difficulties and weight loss (4 exposure groups) and HRQoL scores at each time point. Mean score differences (MDs) between time points or exposure groups were defined as clinically relevant in accordance with evidence-based interpretation guidelines. RESULTS: In total, 92 of 104 10-year survivors (88·5 per cent) responded to the questionnaires. Weight loss was greatest within 6 months of surgery. Patients with eating difficulties with or without weight loss reported clinically and statistically significantly worsened HRQoL in almost all aspects. The largest MD was seen between 5 and 10 years after surgery for global quality of life, physical, role and social function (MD -22 to -30), as well for fatigue, nausea, dyspnoea, insomnia, appetite loss and diarrhoea (MD 24-36). CONCLUSION: Eating difficulties are associated with deterioration in several aspects of HRQoL up to 10 years after surgery for oesophageal cancer.

The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer.

BACKGROUND: Weight loss is a cardinal symptom of oesophageal cancer and is often continued after surgery. High body mass index (BMI) is a strong risk factor for oesophageal adenocarcinoma. This study aimed to assess the impact of pre- and post-operative weight loss and BMI on long-term mortality after resection for oesophageal cancer. METHODS: This prospective and nationwide cohort study included 390 patients, operated on for oesophageal cancer in Sweden in 2001-2005 with follow-up until 2016, who responded to a questionnaire on weight history 6 months after surgery. Multivariable Cox proportional hazard models provided hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality while adjusting for several prognostic factors, including tumour stage. RESULTS: Compared to weight stable patients, pre-surgery weight loss indicated increased HRs of overall all-cause mortality (HR = 1.32, 95% CI 0.94-1.86) and disease-specific mortality (HR = 1.36, 95% CI 0.93-1.98). Patients with >20% weight loss post-surgery had worse overall all-cause mortality (HR = 1.71, 95% CI 1.01-2.88) and disease-specific mortality (HR = 2.20, 95% CI 1.24-3.89). Compared to patients with normal BMI, decreased HRs were indicated for patients who were obese at the time of surgery (overall all-cause mortality HR 0.87 95% CI, 0.58-1.31 and disease-specific mortality HR = 0.89, 95% CI 0.57-1.40), while patients with BMI ≤19.9 at 6 months post-surgery had increased all-cause mortality (HR = 1.41, 95% CI 1.03-1.95) and disease-specific mortality (HR = 1.55, 95% CI 1.09-2.21). CONCLUSION: Post-operative weight loss and low BMI at 6 months post-surgery are independent markers of poor prognosis in patients who undergo surgery for oesophageal cancer.